Bring a large pot of lightly salted water to a boil. Cook elbow macaroni in the boiling water, stirring occasionally, until tender yet firm to the bite, about 8 minutes.
Preheat the oven to 350 degrees F (175 degrees C). Line a baking sheet with aluminum foil.
Melt 2 tablespoons butter in a saucepan over medium heat, about 1 minute. Whisk flour into butter to form a roux. Add milk and cream, stirring to blend. Add Worcestershire sauce, black pepper, and grated Cheddar cheese. Stir until melted, 1 to 3 minutes. Drain macaroni and add to the saucepan. Mix until combined. Spread mixture out onto the prepared baking sheet.
Combine panko bread crumbs, Italian seasoning, and garlic salt in a bowl. Sprinkle mixture over the macaroni and cheese on the baking sheet. Place remaining butter in a small microwave-safe bowl and heat in a microwave oven until melted, about 1 minute. Drizzle melted butter over the macaroni and cheese.
Bake in the preheated oven until bubbling, 15 to 20 minutes.
