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Otorrhea is a common symptom of acute otitis media (AOM). It is sometimes the first and only symptom of AOM with perforation (in the absence of fever or pain). French national and international recommendations consider it as a common symptom, or a sign of severity, of AOM, justifying systematic oral antibiotic therapy, whatever the age of the child and whatever the symptomatic nature (i.e., 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 otorrhea as an isolated symptom of AOM? A systematic review of RCTs and meta-analyses (MAs) of RCTs concerning the antibiotic treatment of otorrhea due to AOM in children was conducted. The Medline and Cochrane databases were consulted up to July 30, 2019. Results: No RCT or MA of RCT evaluated the effect of oral or topical antibiotic therapy in children with asymptomatic otorrhea following AOM with perforation. Conclusion: Current recommendations to systematically treat children with otorrhea as an isolated symptom of AOM with antibiotics are not justified by any RCTs.