Background- This study was designed to determine the frequency of various clinical features in liver abscess and to evaluate the outcome of patients treated by medical management or surgical intervention in terms of hospital stay, cavity reduction time, cost and complications. Method- This is prospective comparative study of 85 patients, presented in in outpatient and emergency department of this hospital with the clinical features of liver abscess during the course of 1.5 years ( january 2020 to june 2021) were included. Patients divided in 4 groups on the basis of usg , patients having cavity size < 5cm were included in group A (n=10) and subjected to conservative management only, patients having cavity size > 5cm underwent percutaneous drainage either by needle aspiration group B (n=21) having volume <100ml or by catheter drainage group D (n=39) having vol>100ml with appropriate antibiotic. Patients with ruptured cavity and signs of peritonitis were included in group C (n=15) and laparotomy was done.outcome of the treatments was evaluated in terms of duration of hospital stay, 50% reduction of cavitysize, total /near total reduction of cavity size, success rate, complication rate and cost. ANOVA test was used to analyze the parameters and determine the results. Result- The most common signs and symptoms were, abdominal pain and right hypochondriac tenderness present in 100% and 78.8% of cases respectively. The success rate of catheter drainage is significantly better (>90%) than other groups (p=0.04) and this group also showed earlier 50% cavity reduction time 7. 4 days, complete cavity reduction time 22.4 days least hospital stay 9.7 days, significantly low complication rate 10.2% than others (p=<0.005) and is most cost effective with avg cost of Rs 2100. Conclusion- Among all the interventions percutaneous pig tail insertion with antibiotic coverage is the best way to treat large liver abscess with thick pus. In case of ruptured liver abscess open surgical method is ideal.