Background Liver abscess is a disease known to mankind since ancient times and has been treated by various means. The introduction of radiology-guided interventional drainage procedures has reduced the mortality rate, which forms a significant part of management. However, there is still a dilemma regarding the procedure of choice in medium-sized liver abscesses mainly in resource-limited developing countries. Methods The study was conducted on 60 patients with moderate-sized (5-10 cm) liver abscess/abscesses, liquified, drainable and divided randomly into two groups with 30 patients each and subjected to either Ultrasound-guided needle aspiration or catheter drainage with identical medical treatment. Outcomes were compared within both groups concerning the need for analgesics, total duration of hospital stay, total days of leave from work and recurrence or residual collection. Results Both groups were comparable in age, gender, type of abscess and maximal diameter. The success rate was equal (80% and 84%). However, the need for analgesics, total duration of hospital stay and total days of leave from work showed a significant (p<0.05) decrease in the needle aspiration group with a mean stay of 9.3 ± 3.18 days and mean leave of 18.9 ± 5.13 days as compared to catheter drainage group with the mean of 14.8 ±5.95 days and 32.5 ±11.4 days respectively. Conclusion Based on our study's results, we conclude that percutaneous needle aspiration is a primary interventional treatment in moderate-sized (5-10 cm) liver abscesses. More multicentric and randomised trials should be done to confirm the inference of this study.