MRI is preferred over CT for concomitant evaluation of the biliary tree and cystic contents (conditional recommendation, low quality of evidence). Monotherapy with antihelminthic drugs is not recommended in symptomatic patients who are surgical or percutaneous treatment candidates (strong recommendation, moderate quality of evidence). Adjunctive therapy with antihelminthic therapy is recommended in patients undergoing PAIR or surgery, and in those with peritoneal rupture or biliary rupture (strong recommendation, low quality of evidence). Percutaneous treatment with PAIR is recommended for patients with active, hydatid cysts who are not surgical candidates, who decline surgery, or who relapse after surgery (strong recommendation, low quality of evidence). Surgery, either laparoscopic or open, based on available expertise, is recommended in complicated hydatid cysts with multiple vesicles, daughter cysts, fistulas, rupture, hemorrhage, or secondary infection (strong recommendation, low quality of evidence).