To assess the impact of new therapeutic strategies on outcomes and hospitalization charges among adult patients with botulism in the United States. We determined in-hospital outcomes and charges for patients with botulism hospitalized in 1993–1994 and compared them with those observed among patients hospitalized in 2006–2007. Mortality, length of stay, and hospitalization charges were calculated. Age, sex, race, ethnicity, and discharge status were also reported. There were 66 and 132 admissions of adult patients with botulism in 1993–1994 and 2006–2007, respectively. Men predominance was observed in 2006–2007 compared to women predominance during the 1993–1994 time period. There was no significant difference in the average length of stay and in-hospital mortality rate between the two groups studied. However, in the 2006–2007 group, there was a significant increase in the mean hospitalization charges (USD 126,092±120,535 vs. USD 83,623±82,084; p= 0.0107) and in the proportion of patients requiring mechanical ventilation when compared to 1993–1994 (34 vs. 13.6%; p< 0.0001). Botulism continues to be an infrequent cause of hospitalization, with a significant increase in the average hospitalization charges in 2006–2007 when compared to 1993–1994, despite a nonsignificant change in the mortality rate and average length of hospitalization.