Background: Liver abscesses are a significant cause of morbidity and mortality worldwide, posing a challenge to both clinicians and patients due to their potential for severe complications and prolonged hospital stays. This study aimed to compare the efficacy and outcomes of catheter drainage (CD) versus percutaneous needle aspiration (PNA) in the management of liver abscesses, focusing on resolution time, success rates, hospital stay, recurrence, and complications.Materials and Methods: A prospective cohort study was conducted on 100 patients diagnosed with liver abscess and allocated into two treatment groups: PNA (n=50) and CD (n=50). Patients were selected based on predefined inclusion and exclusion criteria. CD was performed using an 8–12 Fr pigtail catheter under ultrasound guidance, while PNA was performed using an 18–21G needle. All patients received empirical antibiotic therapy and were monitored for clinical improvement. The primary outcomes included resolution time, success rates, and recurrence, while secondary outcomes included complications and hospital stay. Follow-up was conducted for six weeks with ultrasound evaluation at 1, 3, and 6 weeks. Results: The mean resolution time was significantly shorter in the CD group (9.8 ± 2.7 days) compared to the PNA group (12.5 ± 3.4 days, p=0.002). Complete resolution was achieved in 96% of CD patients versus 84% of PNA patients (p=0.045), while recurrence was higher in the PNA group (16%) than in the CD group (4%, p=0.029). The CD group had a shorter hospital stay (6.1 ± 1.8 days vs. 8.4 ± 2.1 days, p=0.001). Complication rates were similar, but the need for repeat procedures was significantly higher in the PNA group (20% vs. 4%, p=0.009). At six-week follow-up, ultrasound-confirmed resolution was observed in 94% of CD patients and 82% of PNA patients (p=0.032).Conclusion: Catheter drainage proved to be a more effective and reliable treatment for liver abscesses compared to percutaneous needle aspiration. CD resulted in a significantly faster resolution, higher success rates, shorter hospital stays, and lower recurrence rates. Given these advantages, CD should be considered the preferred treatment, particularly in cases of larger abscesses or those requiring prolonged drainage.