Background: The aim of this study was to determine and compare the therapeutic effectiveness and safety of USG guided percutaneous continuous catheter drainage and USG guided percutaneous needle aspiration in the treatment of liver abscess in Trichy. Methods: This is a prospective randomised comparative study of 50 patients, presented in outpatient and emergency department at the hospital, randomised equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of their treatment was measured in terms of duration of hospital stay, time taken for improvement of clinical symptoms, time taken for 50% reduction in cavity size and total or near total reduction of abscess cavity. Independent t-test was used to analyse these parameters. Results: The success rate was significantly better in catheter drainage group. Patients in pigtail catheter drainage group showed earlier clinical improvement (p 0.000) and 50% reduction in abscess cavity volume (p 0.000) and near total reduction of abscess cavity was earlier (p 0.019) as compared to those who underwent percutaneous needle aspiration. Conclusion: Our study concludes that percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration in respect to clinical improvement, reduction of cavity and success rate.