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Otorrhea is a common symptom of acute otitis media (AOM). It is sometimes the first and only symptom of a perforated AOM (absence of fever or pain). National and international recommendations consider it as a noisy symptom or a sign of seriousness of an AOM, justifying systematic oral antibiotic therapy, whatever the age of the child and whatever the symptomatic character (fever or pain). What randomized clinical trials (RCTs) or meta-analyses of RCTs support these recommendations? What is the effectiveness of oral or topical antibiotics in children with isolated otorrhea on AOM? A systematic review of RCTs and meta-analyses of RCTs (MA) concerning the antibiotic treatment of otorrhea isolated on AOM in children was conducted. The Medline and Cochrane databases were consulted until 30/07/2019. Results: No RCT or MA of RCT evaluated the effect of oral or topical antibiotic therapy in children with asymptomatic otorrhea following a perforated AOM. Conclusion: Current recommendations to systematically treat children with isolated otorrhea on AOM with antibiotics are not justified by an RCT. [ABSTRACT FROM AUTHOR]