Safety of Taking 2 Augmentin 500mg Tablets Twice Daily
Taking two Augmentin 500mg tablets twice daily (1000mg amoxicillin/250mg clavulanate BID) is NOT recommended due to excessive clavulanate dosing, which significantly increases the risk of gastrointestinal adverse events, particularly diarrhea. 1
Why This Dosing is Problematic
The Infectious Diseases Society of America explicitly warns against substituting two 250mg tablets for one 500mg tablet because it results in excessive clavulanate dosing. 1 This same principle applies to doubling the 500mg formulation—you would be receiving 250mg of clavulanate per dose instead of the intended 125mg, effectively doubling your clavulanate exposure beyond what is therapeutically necessary or safe.
Clavulanate-Related Adverse Events
- Diarrhea is the most common adverse event with amoxicillin-clavulanate formulations, and its incidence is directly related to clavulanate dose. 2
- Higher clavulanate doses increase gastrointestinal side effects without providing additional therapeutic benefit. 3
- The 500/125mg formulation was specifically designed to balance efficacy against common respiratory pathogens while minimizing clavulanate-related adverse effects. 3
Recommended Dosing Alternatives
For Standard Infections
If you need higher amoxicillin dosing, the appropriate formulation is Augmentin 875/125mg twice daily, NOT two 500mg tablets twice daily. 2, 1 This provides:
- 875mg amoxicillin per dose (higher amoxicillin)
- Only 125mg clavulanate per dose (appropriate clavulanate level)
- Twice-daily dosing for convenience 1
For Severe or Resistant Infections
High-dose amoxicillin-clavulanate (2000mg/125mg twice daily) is the recommended formulation when coverage of penicillin-nonsusceptible Streptococcus pneumoniae is needed. 2 This formulation:
- Provides very high amoxicillin levels (2000mg per dose)
- Maintains appropriate clavulanate levels (125mg per dose)
- Is specifically indicated for drug-resistant pathogens 3
Standard Dosing Options
For mild-to-moderate infections, the standard dose is 500/125mg three times daily OR 875/125mg twice daily. 1, 4 Both regimens provide:
- Adequate coverage for common respiratory and soft tissue infections 1
- Appropriate clavulanate exposure (125mg per dose) 4
- Well-established safety profiles 2
Clinical Implications
The duration of treatment for most respiratory infections is 5-7 days for acute bacterial rhinosinusitis and 7-14 days for other respiratory infections. 1, 4 Completing the full prescribed course is essential to prevent treatment failure and resistance development. 1
If you believe you need higher antibiotic dosing, contact your prescriber to discuss switching to the appropriate high-dose formulation (875/125mg BID or 2000/125mg BID) rather than doubling your current tablets. 2, 1