Online Sinus Infection Treatment (Acute Rhinosinusitis) for Adults
Fast MD-only sinus care by video, $49 flat-fee, no insurance required.
Sinus pressure, facial pain, and thick nasal discharge are common and often caused by viral infections, but sometimes they progress to a true bacterial sinus infection. Our board-certified MDs use evidence-based criteria to distinguish viral from bacterial sinusitis through a video visit and prescribe antibiotics when appropriate.
- Board-certified MD every visit
- Video-only care, no waiting rooms
- $49 flat fee, no insurance needed
- Antibiotics prescribed when medically appropriate
What Is a Sinus Infection?
Acute rhinosinusitis occurs when the sinus passages become inflamed due to viral infections, allergies, or less commonly, bacteria. Most sinus infections start as viral and improve on their own. Only a small percentage meet evidence-based criteria from organizations such as the Infectious Diseases Society of America for a true bacterial sinus infection that may benefit from antibiotics.
Viral Versus Bacterial Sinus Infection
Our MDs follow clinical criteria from major guidelines such as the Infectious Diseases Society of America to determine whether your sinus infection is more likely viral, which does not need antibiotics, or bacterial, where antibiotics may provide benefit.
Viral Sinusitis, Most Common
- Symptoms last less than ten days
- Symptoms begin to improve after day three or four
- Mucus may start clear or slightly cloudy
- Facial pressure, congestion, and mild to moderate headache
- No eye swelling, confusion, or severe focal neurologic symptoms
Bacterial Sinusitis, Acute Bacterial Rhinosinusitis
This is diagnosed when at least one of these patterns is present:
- Persistent symptoms for ten days or longer without meaningful improvement
- Severe symptoms with high fever (one hundred two degrees Fahrenheit or higher), purulent nasal discharge, and marked facial pain for three to four consecutive days at the beginning of illness
- Double worsening, where an illness starts to improve after several days and then clearly worsens again with new or higher fever, increasing nasal discharge, or more intense facial pain
| Symptom pattern | More likely viral | More likely bacterial | Red flag (seek urgent care) |
|---|---|---|---|
| Duration of symptoms | Improving within three to ten days | Ten days or more with little or no improvement, or clear second worsening | Rapid deterioration with high fever and systemic illness |
| Fever | Low-grade or none, improving over time | High fever (around one hundred two degrees Fahrenheit or higher) for three to four days | High fever plus rigid neck, confusion, or trouble waking up |
| Facial pain and pressure | Mild to moderate, often bilateral, gradually improving | Moderate to severe, often localized to one cheek or forehead, worse when bending forward | Severe focal pain with swelling or redness around the eye or forehead |
| Nasal discharge | Clear or mildly cloudy, improving over a week | Thick yellow or green discharge that persists or worsens after day five to seven | Bloody or foul-smelling discharge with facial swelling or visual changes |
| Overall course | Cold-like illness that slowly gets better | Slow, persistent course or “gets better then suddenly worse again” | Rapid progression, severe headache, double vision, confusion, or severe illness |
When a Video Visit Is Appropriate
- Sinus pressure or facial pain
- Congestion and nasal blockage
- Post nasal drip or cough
- Mild to moderate headache
- Thick yellow or green mucus
- Symptoms lasting three to ten days, or a cold that is starting to worsen again
- No concerning red flag symptoms
Red Flag Symptoms, In Person or Emergency Care
- Vision changes or double vision
- Marked swelling or redness on one side of the face
- High fever with stiff neck
- Very severe frontal headache that feels like the worst headache of your life
- Confusion, difficulty speaking, or altered mental status
- Eye swelling, eye redness, or difficulty moving the eye
- History of significant immune compromise (for example, chemotherapy, transplant, uncontrolled HIV)
- Recent facial trauma or suspected cerebrospinal fluid leak
How TeleDirectMD Treats Sinus Infections
Care for Viral Sinusitis
- Saline nasal rinses or sprays to keep mucus thin and improve drainage
- Nasal corticosteroid sprays such as fluticasone or mometasone when appropriate
- Short term use of decongestants when safe for the patient
- Warm compresses over the sinuses to ease pressure
- Humidifier use and adequate hydration
- Elevation of the head during sleep to reduce congestion
When Antibiotics Are Appropriate
Antibiotics are used only when the history and pattern of symptoms strongly suggest acute bacterial rhinosinusitis. During your video visit, your MD will confirm that you meet guideline-based criteria such as:
- Symptoms lasting ten days or longer without meaningful improvement
- Severe symptoms with high fever (one hundred two degrees Fahrenheit or higher), thick nasal discharge, and marked facial pain for at least three to four consecutive days
- A “double worsening” pattern, where a typical cold starts to improve after several days and then clearly worsens again with new or higher fever, increasing nasal discharge, or more intense facial pain
- Absence of red flag findings that would require immediate in person or emergency evaluation instead of routine outpatient treatment
Common Adult Antibiotic Regimens When Indicated
| Antibiotic | Typical adult dose | Usual duration | When we use it |
|---|---|---|---|
| Amoxicillin clavulanate | Eight hundred seventy-five / one hundred twenty-five milligrams twice daily | Five to seven days | First line choice for most healthy adults without penicillin allergy |
| Doxycycline | One hundred milligrams twice daily | Five to seven days | Alternative for adults who cannot take penicillin or when local resistance patterns support its use |
| Cefdinir or Cefpodoxime | Cefdinir three hundred milligrams twice daily, or Cefpodoxime two hundred milligrams twice daily | Five to seven days | Selected cases where a cephalosporin is appropriate based on allergy history and prior treatment |
The exact medication and duration may vary based on your allergy history, prior antibiotic use, other medical conditions, and current guideline recommendations. Fluoroquinolone antibiotics such as levofloxacin are not used as a routine first line choice for uncomplicated sinus infections and are reserved for limited situations because of potential side effects and antibiotic stewardship principles.
Home Care Tips for Sinus Symptoms
- Use saline sprays or rinses once or twice per day if tolerated
- Apply warm compresses over the cheeks and forehead
- Drink plenty of fluids unless you have a medical restriction
- Use a humidifier in dry environments
- Rest as needed and avoid smoking, vaping, or other nasal irritants
Return to Work Guidance
Many adults can return to work once they are fever free for at least twenty four hours without fever reducing medication and their symptoms are improving. If you are prescribed antibiotics for bacterial sinusitis, you may start to feel better within forty eight to seventy two hours, although congestion and fatigue can take longer to fully resolve. Your MD can provide a simple work note when medically appropriate.
TeleDirectMD provides evidence based virtual urgent care for adults, including sinus infections, upper respiratory symptoms, skin concerns, and medication refills. All visits are with a board certified MD by secure video, with clear guidance for when in person care is required.
Adult Sinus Infection Questions and Answers
How do I know if my sinus infection is viral or bacterial?
Viral sinusitis usually improves 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 initial improvement, a pattern sometimes called double worsening.
Do all sinus infections need antibiotics?
No. Most sinus infections are caused by viruses and do not require antibiotics. Antibiotics are reserved for cases where the pattern of illness suggests a bacterial infection, to avoid unnecessary side effects and antibiotic resistance.
How long does a sinus infection usually last?
Viral sinus infections typically last between three and ten days. Bacterial sinus infections tend to last longer, but if appropriate antibiotics are started, many people notice improvement within two to three days even though congestion can take longer to fully resolve.
Which antibiotics are commonly used for bacterial sinusitis?
Amoxicillin clavulanate is often used as a first line option for bacterial sinusitis in adults. Doxycycline is a commonly used alternative for some adults who cannot take penicillin, and cephalosporins such as cefdinir or cefpodoxime may be used in selected situations based on your history and local resistance patterns.
Are sinus infections contagious?
The respiratory viruses that trigger many sinus infections can be contagious and may spread from person to person, especially through coughing, sneezing, or close contact. The bacterial phase of a sinus infection is less about contagion and more about how the illness has progressed in an individual patient.
Can a sinus infection cause a fever?
Yes. Fever can occur early in a viral upper respiratory infection and can also be present in more severe or prolonged bacterial sinus infections, particularly when there is facial pain and thick nasal discharge.
Can sinus infections cause ear pressure or headaches?
Yes. Inflammation and congestion in the sinus passages can lead to ear fullness, headaches, and facial pressure, especially around the cheeks, forehead, and behind the eyes.
Can I take antibiotics just in case?
No. Using antibiotics when they are not needed does not speed recovery from viral infections and increases the risk of side effects, allergic reactions, and antibiotic resistant bacteria. They should only be used when there is a clear indication for bacterial sinusitis.
When should I seek emergency care for sinus symptoms?
Seek urgent or emergency care if you develop vision changes, very severe headache, swelling around the eye or face, difficulty moving the eye, confusion, stiff neck, or other concerning neurologic symptoms, because these may signal a serious complication.
Is telehealth a safe way to evaluate sinus infections?
Yes. Acute sinusitis is generally diagnosed based on your symptoms and physical findings rather than routine imaging or lab tests. A telehealth visit allows a physician to review your history, assess for red flags, and recommend appropriate treatment or in person follow up when needed.
How quickly will I feel better after starting treatment?
Viral sinus symptoms usually improve gradually with supportive care over several days. When bacterial sinusitis is treated with an appropriate antibiotic, many adults notice less facial pain, pressure, and nasal discharge within two to three days, although full recovery may take a week or more.
What should I do if my symptoms are not improving?
If your symptoms do not improve after several days of treatment, or if they worsen, an in person evaluation may be needed to confirm the diagnosis, rule out complications, and adjust your treatment plan.