Background: Infection ,specially febrile neutropenia (FN) , is the major cause of morbidity and mortality of neoadjuvant (NEO) and adjuvant (ADJ) chemotherapy for breast cancer. Timely evaluation by health care professionals and antibiotics (ABx) are recommended. However, access to care can be delayed at night and weekend. Most pts receiving NEO and ADJ chemotherapy are low risk for complication of FN and can be safely managed with oral ABx at home. Our hospital began patient self-initiated approach for fever and this study analyzed the strategy outcome. Methods: Retrospective review of electronic medical records of pts who underwent anthracycline and taxane based NEO or ADJ chemotherapy for breast cancer at a hospital was performed. Pts were prescribed with 7 days of ciprofloxacin+ amoxicillin/ clavulanate on the 1^st day of chemotherapy unless contraindicated and instructed to start immediate ABx for axillary temperature ≥ 38 °C. G-CSF was not routinely given. Chemotherapy induced infection was defined as any infection occurring from the 1^stchemotherapy day to 3 weeks after the last chemotherapy. Results: From February 2011 to December 2014, 855 pts received NEO or ADJ chemotherapy. 362 pts received triweekly doxorubicin+ cyclophosphamide (AC) or fluorouracil+ epirubicin+ cyclophosphamide (FEC) and triweekly docetaxel, 357 pts received triweekly AC / FEC and weekly paclitaxel, 122 pts received triweekly docetaxel+ cyclophosphamide (TC), and 14 pts received docetaxel+ carboplatin + trastuzumab (TCH). Prophylactic ABx was prescribed to 794 pts (93%). 331 pts (39%) used ABx for fever. 15 pts (1.7%) were hospitalized due to infection (5 FN, 4 surgical site infection, 2 pneumonia, 2 zoster, 1 perianal abscess, 1 appendicitis). Three of 61 pts (5%) who did not have prescribed prophylactic ABx were hospitalized due to infection whereas 12 of 794 (1.5%) with prophylactic ABx prescription were hospitalized from infection (p = 0.085). There was no therapy related death. Conclusions: Patient self-initiated ABx therapy for fever during NEO or ADJ breast cancer chemotherapy was safe and may reduce infection related hospital admission. Prospective validation is needed to generalize this strategy.