A large-scale implementation trial in China demonstrates that antibiotic stewardship programs can effectively reduce antimicrobial resistance when designed to integrate seamlessly with existing healthcare workflows in resource-constrained environments. The pragmatic approach focused on interventions that healthcare workers could realistically implement without additional staffing or complex technology requirements. This addresses a critical gap in antibiotic resistance research, which has predominantly focused on high-resource settings with dedicated infectious disease specialists and robust laboratory infrastructure. The finding is particularly significant given that resource-limited settings account for the majority of global antibiotic consumption and often lack the surveillance systems to track resistance patterns. Previous stewardship efforts in low-resource contexts have frequently failed due to overly complex protocols or unrealistic implementation requirements. The Chinese model suggests that simplified, workflow-integrated interventions may offer a scalable solution for the global antibiotic resistance crisis. However, the generalizability across different healthcare systems and cultural contexts remains to be established, and long-term sustainability will depend on continued institutional support and ongoing monitoring of resistance patterns.