A Decision Support System (DSS) was developed and evaluated to control the Mediterranean fruit fly (medfly), Ceratitis capitata (Wiedermann), by incorporating a semi-automatic pest monitoring and a precision targeting approach in multi-varietal orchards. The DSS consists of three algorithms. DSS1, based on the degree days calculation, defines when the traps should be deployed in the field initiating the medfly population monitoring. DSS2 defines the areas to be treated and the type of treatment based on the number of adult medfly captures, harvesting time, and phenological stage of the host cultivar. DSS3 defines the spraying procedure considering the technical registration properties of the selected insecticide (e.g., withholding period and efficacy duration time) and weather conditions. The DSS was tested in commercial orchard conditions near Rome, central Italy, with a randomized complete blocks experimental design, comparing DSS-assisted and conventional management. In the DSS-assisted plots, a semi-automatic adult medfly monitoring system was deployed, composed of real-time, wireless electronic traps. The output of the functioning DSS is a map of spraying recommendation, reporting the areas to be treated and the treatment type (bait or cover insecticide spraying). The farmer was left free to follow, or not, the DSS indications. The first medfly captures were observed on June 30, whereas the DD threshold was reached on July 3 when the DSS started to operate. The field test produced 29 DSS decisions from July 3 to September 1 and confirmed that medfly management using the DSS substantially reduced the number of pesticide applications, the treated area, and the volumes of pesticide utilization. No significant differences in infested fruit were observed between DSS-assisted and conventional management. The level of acceptance of the DSS by the farmer was 78%. This evidence confirmed the requirement of fully involving farmers and pest managers during the evaluation process of DSS.