Sinus infection in Puerto Rico: online treatment

Sinusitis is inflammation of the sinuses, the air spaces behind your forehead, cheeks and nose. Most sinus infections are caused by the same viruses that cause colds and clear up on their own within a week or two; some are bacterial.

Green or yellow mucus does not by itself mean the infection is bacterial or that you need an antibiotic. Poorly controlled allergies, tobacco smoke and mold can also cause or worsen sinusitis. MedlinePlus lists toothache among the symptoms, because pressure in the cheek sinuses is felt in the upper teeth; if the pain comes from one tooth, see toothache.

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A sinus infection is handled in a doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. A doctor’s note after your visit is included at no extra charge.

We do not bill insurance; the pharmacy charges separately. See all prices. The service is run by The Health Initiative, a nonprofit.

Acute sinusitis often follows a cold that doesn’t get better, or gets worse, after 7 to 10 days. The most common symptoms are:

• Stuffy or runny nose
• Pain or pressure in the face, behind the eyes or in the upper teeth
• Headache
• Mucus dripping down the throat and a sore throat
• Cough, often worse at night
• Bad breath or loss of smell
• Tiredness and sometimes fever

The CDC says a bacterial infection is more likely with severe symptoms (bad headache or facial pain), symptoms that get worse after improving, symptoms lasting more than 10 days without improving, or fever lasting more than 3 to 4 days. In those cases the doctor decides whether an antibiotic is appropriate; sometimes it is better to watch for 2 to 3 days before starting one.

The IDSA (Infectious Diseases Society of America) 2012 guideline estimates that only 2% to 10% of acute sinus infections are bacterial; the vast majority are viral. When an antibiotic is needed, guidelines use amoxicillin or amoxicillin-clavulanate first (the CDC, for children); the IDSA prefers amoxicillin-clavulanate. If you are allergic to penicillin, tell the doctor so she can choose another option. Read more about antibiotics.

When an antibiotic isn’t needed, it doesn’t help and can cause side effects, allergic reactions, antibiotic resistance or a C. difficile gut infection. A sinus infection rarely needs tests; if the doctor thinks one is needed, we give you a lab order. If you get more than 2 or 3 sinus infections a year, or symptoms last more than 12 weeks, she guides you to an ear, nose and throat or allergy specialist.

These steps ease congestion and pain while your body fights the infection:

• Put a warm, moist washcloth on your face several times a day.
• Drink plenty of fluids to thin the mucus.
• Breathe in steam, for example in the bathroom with a hot shower running.
• Use saline (salt water) nasal sprays or rinses.
• Decongestant nasal sprays may help at first, but using them for more than 3 days can make congestion worse.
• For pain, acetaminophen or ibuprofen as directed on the label or by your doctor.
• To prevent it: wash your hands, get a flu shot every year, avoid tobacco smoke and keep your allergies under control.
• Puerto Rico’s humidity helps mold grow, and mold can cause congestion and cough in sensitive people: keeping your home dry helps.

In children, a bacterial sinus infection is more likely when cold symptoms (runny nose, daytime cough) last more than 10 days without improving, when fever and thick nasal discharge last 3 or 4 days, or when a child gets better and then worse again. An ordinary cold usually lasts about 7 days.

The doctor evaluates your child by video with you on camera and, if appropriate, prescribes and we send the prescription to your pharmacy. At home, saline drops and a cool-mist humidifier help a stuffy nose. Never give aspirin to a child, and over-the-counter cough and cold medicines are not recommended under age 4. Patients under 21 need a parent or legal guardian on camera with ID. See our online doctor for kids.

For safety: a baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs the emergency room right away.

Complications are rare, but a sinus infection can spread to the eye or the brain. For your safety, go to the emergency room or call 911 if you notice these signs. See when to go to the ER.

• Swelling or redness around the eye
• Double or blurred vision, or any change in vision
• Severe headache or a stiff neck
• New confusion or unusual drowsiness
• High fever with worsening illness
• A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher