The Adobe PDF printer is no longer available with Acrobat and MacOS due to changes Apple made in the operating system a number of releases ago that prevent the functionality that Acrobat had. Sorry, but this is nothing that Adobe can fix. There are other methods of producing PDF provided natively by MacOS and by Acrobat that don't involve distillation of PostScript.
I note that you did try the other mechanism(s) but were dissatisfied with the file size or alternatively the file quality. Sorry, but (1) the old print PDF via distillation of PostScript method would have had the same issues and (2) you simply can't legislate PDF file size. For raster images, the only ways to reduce resultant PDF file sizes is to either use lossier compression or downsample the image. Either of those methods can result is poor quality. You might experiment with various settings to see if you a combination that does yield a smaller file size but quality that is not as bad as you currently are getting.
- Dov