How do I know if my sinus infection is viral or bacterial?

Viral sinus infections usually improve within three to ten days, with symptoms gradually getting better. Bacterial sinusitis is more likely if symptoms last at least ten days without improvement, are severe for several days with high fever and facial pain, or worsen again after initially starting to improve, a pattern sometimes called double worsening. TeleDirectMD physicians use guideline-based criteria during your video visit to distinguish likely viral from likely bacterial sinusitis.

Do all sinus infections need antibiotics?

No. Most sinus infections are viral and get better with time and supportive care alone. Antibiotics are reserved for adults who meet clear criteria for acute bacterial sinusitis, such as persistent symptoms beyond ten days, very severe symptoms with high fever and localized facial pain, or symptoms that worsen again after initial improvement. Using antibiotics only when indicated reduces side effects and antibiotic resistance.

What treatments does TeleDirectMD usually recommend for sinus infections?

For viral sinus infections, TeleDirectMD physicians focus on supportive measures such as nasal saline rinses, intranasal corticosteroid sprays when appropriate, over-the-counter pain relievers, hydration, and humidification. When you meet criteria for acute bacterial rhinosinusitis and it is safe to manage by telehealth, your MD may prescribe antibiotics such as amoxicillin-clavulanate or doxycycline, individualized to your history and allergies.

Can a sinus infection be evaluated and treated through an online visit?

Yes. Many adults with sinus symptoms can be safely evaluated by telehealth. During a TeleDirectMD visit, your physician reviews the timing of your symptoms, severity, prior episodes, medication use, and red-flag features. When your pattern fits uncomplicated sinusitis and you have no warning signs, treatment and a follow-up plan can often be managed entirely online.

When is a sinus infection too serious for telehealth-only care?

In-person or emergency evaluation is recommended for high fever with severe facial pain, swelling or redness around the eye, vision changes, double vision, severe headache different from usual, confusion, stiff neck, focal neurologic symptoms, or severe illness in someone who is immunocompromised. Your TeleDirectMD physician screens carefully for these features and will direct you to urgent in-person care if any are present.

What makes TeleDirectMD different for sinus infection care?

TeleDirectMD uses MD-only video visits, follows evidence-based criteria for when antibiotics are useful, and emphasizes clear safety rules for when in-person care is needed. Adults 18 and older can schedule a $49 flat-fee visit with no insurance requirement in more than twenty-five states, receive practical supportive care guidance, and get appropriate prescriptions sent electronically to a local pharmacy when indicated.

Adult Bacterial Sinusitis Treatment (Acute Bacterial Rhinosinusitis)

MD-only sinus infection care by secure online video visit, $49 flat-fee, no insurance required.

Acute bacterial rhinosinusitis is a bacterial infection of the sinuses that can develop after an upper respiratory infection. Many sinus symptoms are viral and improve without antibiotics. Our MDs use guideline-based criteria to distinguish viral rhinosinusitis from bacterial sinusitis, recommend evidence-based symptom relief, and prescribe antibiotics only when clinically appropriate.

$49 flat-fee adult visit
MD-only care (no mid-levels)
No insurance required
Secure video visits in 25+ states

Book a Visit View All Adult Conditions

Last reviewed on January 21, 2026 by Parth Bhavsar, MD

Online MD-Only Bacterial Sinusitis Care

Adult 18+ evaluation using bacterial vs viral criteria
Symptom relief plans for congestion, pressure, and cough
Antibiotics only when indicated, with stewardship focus
Clear triage for eye swelling, severe headache, or neurologic symptoms

Adults 18+ only. No controlled substances are prescribed through TeleDirectMD. Eye swelling, vision changes, severe headache with neck stiffness, confusion, or persistent high fever requires urgent in-person evaluation.

What Is Adult Bacterial Sinusitis (Acute Bacterial Rhinosinusitis)?

Rhinosinusitis means inflammation of the nasal passages and sinuses. Most acute cases are viral and improve with time and supportive care. Acute bacterial rhinosinusitis is suspected when symptoms follow specific patterns that suggest bacterial overgrowth, such as symptoms lasting at least 10 days without improvement, severe onset with high fever and purulent nasal discharge for at least 3 days to 4 days, or worsening after initial improvement.

TeleDirectMD focuses on confirming whether your symptoms fit bacterial criteria, checking for complications that require in-person evaluation, and building a treatment plan that balances symptom relief with antibiotic stewardship.

Symptoms and Red Flags in Adult Bacterial Sinusitis

Many adults with sinus symptoms can be managed via telehealth. Certain symptoms suggest complications such as orbital cellulitis, intracranial spread, severe dehydration, or another diagnosis that needs urgent in-person evaluation.

Symptom or situation	What it suggests	Telehealth appropriate?	Red flag requiring urgent in-person care
Nasal congestion, facial pressure, cough after a cold	Often viral rhinosinusitis	Yes, common telehealth scenario	No red flag unless severe or atypical
Symptoms at least 10 days without improvement	Possible bacterial sinusitis	Yes, often appropriate	No
Severe onset with fever 39 C or higher plus purulent nasal discharge or facial pain	Higher likelihood bacterial sinusitis	Yes, if stable and no red flags	Urgent in-person care if toxic appearance or dehydration
Worsening after initial improvement around day 5 to 7	Double worsening, possible bacterial sinusitis	Yes	No
Swelling or redness around the eye, painful eye movement, vision changes, proptosis	Possible orbital cellulitis or abscess	No	Emergency care immediately
Severe headache, neck stiffness, confusion, focal weakness, seizures	Possible intracranial complication or meningitis	No	Emergency care immediately
Persistent high fever, severe facial swelling, severe unilateral pain out of proportion	Complication or alternate diagnosis	No as sole management	Urgent in-person evaluation
Immunosuppression or major comorbidities with severe symptoms	Higher risk and narrower safety margin	Telehealth may triage	In-person evaluation recommended if moderate to severe symptoms

Differential Diagnosis: Bacterial Sinusitis vs Other Conditions

During your TeleDirectMD visit, the MD will use symptom timing, fever pattern, facial pain distribution, and risk factors to distinguish bacterial sinusitis from other causes of congestion and headache.

Findings Consistent With Bacterial Sinusitis

Symptoms at least 10 days without improvement
Severe onset with high fever and purulent discharge for 3 days to 4 days
Double worsening after initial improvement
Localized facial pain or pressure, often unilateral

Other Conditions Considered

Viral upper respiratory infection: Most common cause, improves gradually within 7 days to 10 days.
Allergic rhinitis: Itching, sneezing, watery drainage, seasonal pattern.
Dental source pain: Upper tooth pain from dental infection can mimic sinus pressure.
Primary headache disorders: Migraine or tension headache can be mistaken for sinus pain.

If symptoms suggest orbital involvement, neurologic complications, or another high-risk diagnosis, our MDs will direct you to urgent in-person evaluation.

When Is a Video Visit Appropriate for Adult Bacterial Sinusitis?

When a Video Visit Is Appropriate

Adult 18+ with sinus symptoms that meet bacterial criteria or need triage
No eye swelling, vision changes, or painful eye movement
No confusion, neck stiffness, focal weakness, or severe headache pattern change
Able to hydrate and not vomiting persistently
Willing to use supportive care and follow antibiotic guidance when indicated

Red Flags Requiring In-Person or ER Care

Swollen or red eyelid, vision changes, proptosis, or painful eye movement
Severe headache with neck stiffness, confusion, weakness, or seizures
Persistent high fever with toxic appearance or dehydration
Severe facial swelling or severe unilateral pain out of proportion
Significant immunosuppression with moderate to severe symptoms

If any red-flag symptoms are present, seek urgent in-person or emergency care. TeleDirectMD is not an emergency service.

Treatment Options for Adult Bacterial Sinusitis

Treatment focuses on symptom relief and selective antibiotic use when criteria are met. Many adults improve with supportive care alone. When bacterial sinusitis is likely, antibiotics can shorten illness and reduce risk of complications, but unnecessary antibiotics add side effects and resistance risk.

Supportive Care

Saline irrigation or saline spray to reduce congestion and mucus.
Intranasal steroid spray for inflammation, especially with allergy overlap.
Acetaminophen or NSAIDs for pain or fever when safe.
Hydration, sleep, and humidified air.

Antibiotics When Clinically Appropriate

Antibiotics are generally considered when symptoms meet bacterial criteria and there are no signs of complications requiring in-person care.
First-line choices are selected to balance effectiveness and stewardship, with dosing adjusted for allergies and kidney function.
TeleDirectMD avoids systemic fluoroquinolones for routine sinusitis treatment.

If symptoms are mild and early, a watchful waiting approach with strong symptom relief may be recommended, with clear instructions on when to start antibiotics or seek follow-up based on progression.

Common Medications Used for Adult Bacterial Sinusitis

The best regimen depends on symptom pattern, allergy history, recent antibiotics, and kidney function. The table below shows typical examples an MD may consider for adults appropriate for telehealth.

Medication	Dose	Duration	When it is used
Amoxicillin-clavulanate 875 mg 125 mg tablet	875 mg 125 mg by mouth 2 times daily with food as directed	5 days to 7 days	Common first-line antibiotic when bacterial criteria are met and no penicillin allergy
Doxycycline 100 mg capsule	100 mg by mouth 2 times daily as directed	5 days to 7 days	Alternative for adults with penicillin allergy when appropriate
Fluticasone nasal spray 50 mcg per spray	2 sprays per nostril once daily as directed	10 days to 14 days, or longer if chronic rhinitis overlap	Inflammation control and congestion relief
Saline irrigation	Use as directed 1 time to 2 times daily	As needed	Mucus clearance and symptom relief

These are example regimens only. Actual medications, strengths, and durations are determined by the MD after reviewing your history, allergies, contraindications, kidney function, and other medications.

Home Care, Expectations, and Return to Work

Viral sinus symptoms often improve within 7 days to 10 days. When bacterial sinusitis is present and treated appropriately, many adults begin to improve within 48 hours to 72 hours after starting antibiotics, though congestion and cough can linger longer.

Use supportive care consistently for symptom relief.
If antibiotics are prescribed, take them exactly as directed and do not save doses for later.
Return to work is often reasonable when fever is gone and symptoms are manageable, especially for non-physical jobs.
Seek urgent care for eye symptoms, severe headache, confusion, or worsening despite treatment.

TeleDirectMD Telehealth Disclaimer

TeleDirectMD provides MD-only virtual urgent care for adults using secure video visits to evaluate sinus symptoms and bacterial sinusitis. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians use evidence-based criteria to distinguish viral versus bacterial illness, recommend symptom relief, and prescribe antibiotics only when clinically appropriate. TeleDirectMD is not an emergency service or a replacement for comprehensive in-person care.

Adult Bacterial Sinusitis Treatment FAQs

How do you tell viral sinusitis from bacterial sinusitis?

Bacterial sinusitis is more likely when symptoms last at least 10 days without improvement, when there is severe onset with high fever and purulent discharge for 3 days to 4 days, or when symptoms worsen after initial improvement.

Do I always need antibiotics for sinus symptoms?

No. Most sinus symptoms are viral and improve without antibiotics. When bacterial criteria are met, antibiotics may help shorten illness and reduce complications, but unnecessary antibiotics add side effects and resistance risk.

Can TeleDirectMD treat bacterial sinusitis through an online visit for adults?

Yes, for many adults 18+ without red flags. Our MDs can evaluate your symptom timeline, fever pattern, and facial pain distribution, recommend supportive care, and prescribe antibiotics when clinically appropriate.

What is the first-line antibiotic for adult bacterial sinusitis?

Amoxicillin-clavulanate is commonly used first-line when bacterial criteria are met and there is no penicillin allergy. The exact choice depends on allergies, recent antibiotics, and other risk factors.

How quickly should I feel better after starting antibiotics?

Many adults start improving within 48 hours to 72 hours. Congestion and cough can take longer. If you are worsening, develop red flags, or have no improvement after several days, you should follow up.

What supportive treatments help the most?

Saline irrigation, intranasal steroid spray, hydration, humidified air, and pain relievers when safe can improve comfort. Avoid overusing topical decongestant sprays, which can cause rebound congestion.

When is sinusitis dangerous?

It is dangerous if there is eye swelling, vision changes, painful eye movement, severe headache with neck stiffness, confusion, focal weakness, or persistent high fever with toxic appearance. Those require urgent in-person evaluation.

Can allergies cause sinus pressure that feels like an infection?

Yes. Allergic rhinitis can cause congestion, pressure, and postnasal drip that mimic sinus infection. Allergy-focused treatment can be more appropriate when symptoms are itchy, seasonal, and not associated with bacterial criteria.

Why does TeleDirectMD focus on antibiotic stewardship?

Antibiotics help when bacterial sinusitis is likely, but most sinus symptoms are viral. Stewardship reduces avoidable side effects and helps slow antibiotic resistance while still treating true bacterial infections appropriately.

What makes TeleDirectMD different for adult bacterial sinusitis care?

TeleDirectMD provides MD-only, guideline-based evaluation by secure video visit with a $49 flat-fee model in 25+ states. We use viral versus bacterial criteria, emphasize symptom relief, and prescribe antibiotics only when clinically appropriate, with clear red flag triage.

Not sure if this is viral or bacterial?

$49 flat fee. Adult-only video visits. MD-only care. Clear criteria, symptom relief, and antibiotics only when appropriate.