Background An amebic liver abscess (ALA) remains a major public health concern in endemic regions, with alcohol consumption as a key predisposing factor. Despite advances in diagnostics and therapeutics, delayed diagnosis and inadequate management continue to contribute to patient morbidity. This study evaluates the clinical features, hepatobiliary involvement, and outcomes associated with a structured treatment approach in ALA. Methods This prospective observational study included 50 patients diagnosed with ALA at a tertiary care center between 2022 and 2024. Demographic data, clinical presentation, laboratory values, and imaging findings were assessed. Patients were treated with either antibiotics alone, percutaneous needle aspiration, or pigtail catheter drainage. Outcomes, including hospital stay, recurrence, and mortality, were recorded over a three-month follow-up period. Results The mean age was 45.76 ± 10.2 years, with a male predominance (44 patients, 88%). Alcohol use was observed in 49 patients (98%), followed by malnutrition in 24 (48%) and anemia in 21 (42%). Jaundice was present in 25 patients (49%), suggesting significant hepatobiliary involvement. Right lobe abscesses occurred in 47 patients (94%). Antibiotic therapy alone was effective in 20 patients (40%), while 13 (26%) required needle aspiration and 17 (34%) underwent pigtail catheter drainage. Patients managed with pigtail drainage demonstrated more rapid symptom resolution. The mean hospital stay was 8.2 days. No recurrence or mortality was observed during follow-up. Conclusion This study highlights the importance of early diagnosis and individualized treatment in optimizing outcomes for ALA. The high rate of jaundice underscores the need for routine liver function evaluation. A structured approach, especially the use of percutaneous drainage in larger abscesses, was associated with excellent recovery. Community-based alcohol cessation initiatives may reduce ALA incidence in endemic regions.