A cluster randomized trial across rural Chinese clinics demonstrated that combining physician training with real-time decision prompts and patient smartphone education reduced inappropriate antibiotic prescribing for respiratory infections by approximately 50% over 12 months. The intervention targeted the critical junction where clinical knowledge meets patient expectations. This finding addresses a global health crisis where antibiotic resistance threatens to reverse decades of medical progress. Rural and developing regions often show the highest rates of inappropriate antibiotic use, making this intervention model particularly valuable for scaling worldwide. The dual approach—educating both prescribers and patients simultaneously—appears more effective than targeting either group alone, which previous studies have attempted with mixed results. The smartphone-based patient component is especially relevant as mobile health tools become ubiquitous even in resource-limited settings. However, the sustainability of these behavioral changes beyond the 12-month study period remains unclear, and cultural factors specific to Chinese healthcare-seeking behavior may limit direct transferability to other populations. The intervention's effectiveness suggests that antibiotic stewardship can succeed without restricting physician autonomy when proper education and feedback systems are implemented.