Modern treatment of liver abscesses comprises combination of antibiotics and image‑guided percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD). However, there is debate regarding the choice of these interventions as the first line of management. Our aim was to compare the results of ultrasound‑guided PCD with PNA in the management of liver abscesses. Materials and Methods: A total of 66 patients (55 males; 11 females, 18–65 years) who were diagnosed with liver abscesses were randomly divided into two groups of 33 patients each, namely ultrasound‑guided PNA group (with a maximum of three attempts) and the PCD group. The outcomes of the treatment of the patients of these groups were documented and analyzed. Results: PNA was effective in 20 (61%) of the 33 patients after one (n = 14), two (n = 4), or three (n = 2) aspirations while PCD was therapeutic in all 33 patients after one (n = 29) or two (n = 4) procedures and without any major complications in both groups. All abscesses 45 mm or less in longest dimension were efficaciously managed, by both PCD as well as PNA while the later failed in case of multiloculated abscesses. The mean duration of intravenous antibiotics and time to clinical relief were significantly lesser in the PCD group. However, a period of hospital stay and time to complete resolution of abscess cavities did not differ significantly between the groups. Conclusions: Overall, PCD is more effective than PNA in the management of liver abscesses; the later, however, can be employed for smaller and simple abscesses.