Sinkhole flooding is an essential hydrological process to recharge karst aquifer in arid to dry sub-humid regions. On the other hand, the increase of rain extremes is one of the major consequences of the global warming, together with the expansion of drylands. Thus, appropriate runoff regulation in endorheic karst basins in order to reduce the risk of flooding and improve the quantity and quality of the water drained by sinkholes will be more and more crucial. With these premises, a systematic review was performed by using WoS engine to infer the best practices for the karst water management in regions actually or potentially affected by water scarcity. Hydrological models are essential to manage the consequences of climate change on karst water resource, however the review shows that providing the tools necessary for reliable modeling is still challenging. Finally, due to the intrinsic vulnerability of the karst aquifers, pollution reduction and wastewater recycling policy will play key role in the next decades.