Sicily (East or West)?

Palermo and Cefalù are in the north coast and Agrigento is on the south coast. If Mt. Etna is a must, then stick to the east coast; Taormina and Syracusa.

To me, seeing more than a couple cities, is unrealistic with the time you have.

There are a lot of sights in and around Palermo. I'm not sure how much time you'll have left after you consider your options there.

I considered hopping over to Malta after I spent 17-18 days (not long enough) in Sicily back in 2015, but I didn't like the ferry situation. It departs from an obscure town you wouldn't otherwise visit, and I though the cost was very high for such a short trip. Perhaps the cost situation, at least, has changed. But I would recommend checking the flight options on skyscanner.com.

If you are coming into Palermo and also want to see Mount Etna, with only 4-5 days I would keep it very simple- 1-2 days in Palermo, then get the train to either Taormina or Catania and spend 2-3 days there, from where you can visit Mount Etna and then fly to Valletta.

I'd spend more time in Palermo than in Taormina/Catania, but I guess that's because I'm more of an urban sightseer than a nature/scenery person. Also, Taormina is crammed with tourists when there's a cruise ship in port at Messina. I could only stand it for 2 or 3 hours. I'm not the only one who had that reaction, but there are definitely people who love Taormina, so YMMV.

You're already taking the ferry from Naples to Palermo. That's a nice crossing; especially as an overnight as it replaces a hotel + a day of travel. There's no good reason to do a second ferry from Pozzallo; a port that's on the exact opposite side of the island and really isn't much of a destination in its own right.

Palermo & surrounding area is an absolute gem IMO and well worth 4-5 nights. The thing is... you really don't have much time in Sicily so a transit all the way across to the east side of the island to see Etna seems to me like a poor use of your very limited time.

Alternatively you could skip Palermo, fly from the Italian mainland to Catania, spend time there and visiting Etna and then take the train down to the Pozzallo. (or fly to Malta)

Another off-the-board option is to spend a couple of 2-3 nights in Catania/Etna and 2-3 nights in the Baroque hill towns. Renting a car isn't a bad idea of you do this. Drop the car in Pozzallo.

I don't think Agrigento works particularly well with any of this. You're just adding another poorly connected destination in a short visit.

Thank you to everyone who resonded to my inquiry. Clearly eastbound is the way to go. Lots of options, lots of recommendations from Rick's guidebooks. Now to make sense, and sell it to my travel partner. Hopefull see you on the Eurotrails! Be safe! Happy adventures!

Ok, but Palermo isn’t East. You’re thinking of Catania maybe?

We did a similar route but for a longer period, I’d stick to the east side tbh. Trying to squeeze in Agrigento from Palermo and then getting back across the island eats up a lot of time. Taormina , Etna ,Syracuse already fill those days nicely without rushing.
Etna is 100% worth it, you can do a half or full day from Catania/Taormina. Syracuse (Ortigia) was actually one of our favorite stops, more relaxed than Palermo. For ferries, we used this for naples-palermo and this for pozzallo-malta
just to line things up with our days, made it pretty easy to plan around timings. The Pozzallo to Valletta ferry is short and kinda fun, so I’d keep it unless you’re really tight on time. Didn’t notice anything major about water issues in Agrigento when we were planning, but we skipped it mainly because of logistics, not that.

With your short time in Sicily, I'd suggest flying from Catania to Malta. It's cheaper and faster ... I just checked a random date (May 13). Flight is $18 and 50 minutes. Ferry is $94, 1 hour, 45 min., which isn't bad but you also have to factor in the time it takes you to travel to Pozzallo. And the always possible ferry cancellation due to bad weather, which happened to us -- we were planning to take this ferry once.

Thank you all! I'm going to go to Palermo (overnight) then Cefalu for a beach day (promise to spouse), then to Mt. Etna for 2-3 days then onto Malta. There is much negative press about Air Malta out of Catania. Anyone have experience with them? Alternative is ITA which I have flown on before but is more expensive.