Hydatid disease, a zoonotic infection by Echinococcus parasites, prevalent in livestock-rearing areas, is transmitted through ingestion of dog feces-contaminated food or water. It leads to two forms: alveolar echinococcosis by Echinococcus multilocularis and cystic echinococcosis by Echinococcus granulosus, forming cysts in the liver, lungs, and potentially other organs. Untreated, these cysts can lead to severe health issues, including organ failure and death. Although in the early days these cysts were treated with surgery based on the characteristics of the cyst, recent advances have offered various drug treatments and percutaneous techniques such as PAIR (puncture, aspiration, injection, re-aspiration). Surgery aims at complete removal and cure, but medical approaches are preferred, especially for inoperable cases, adjuvant therapy, or multiple cysts in different organs. Pharmacological therapy employs the use of benzimidazoles—mainly albendazole and mebendazole. Other drugs, mostly used in combination with benzimidazoles, include praziquantel, mefloquine, amphotericin B, and nitazoxanide. For managing hydatid disease, current medical strategies include the use of these drugs alone, in combination regimens, alongside PAIR, or as adjuvants to surgery. The choice of treatment depends on factors such as cyst size and location, complications, previous treatment outcomes, and disease severity, emphasizing personalized treatment planning. The Echinococcus genus causes hydatid disease, a global zoonotic infection prevalent in livestock-raising areas. Transmission primarily occurs through consumption of food or water contaminated with dog feces. Surgery offers potential for a complete cure, but medical strategies also treat hydatid disease, especially where surgery is not viable or as supplementary therapy. For patients with multiple, diversely located cysts, medical treatment is advised first, tailored to factors like cyst size, location, complications, prior treatment response, and disease stage. Pharmacological treatment mainly uses benzimidazoles (albendazole, mebendazole) and may include praziquantel, mefloquine, amphotericin B, and nitazoxamide, often in combination. This chapter details available medical treatments, their standalone use or with PAIR, and pre-surgical application.